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Definition of Acceptable "Professional Review Action"


The term "professional review action" means an action or recommendation of a professional review body which is taken or made in the conduct of professional review activity, which is based on the competence or professional conduct of an individual physician (which conduct affects or could affect adversely the health or welfare of a patient or patients), and which affects (or may affect) adversely the clinical privileges, or membership in a professional society, of the physician. Such term includes a formal decision of a professional review body not to take an action or make a recommendation described in the previous sentence and also includes professional review activities relating to a professional review action. ... [A]n action is not considered to be based on the competence or professional conduct of a physician if the action is primarily based on--

(A)
the physician's association, or lack of association, with a professional society or association;

(B)
the physician's fees or the physician's advertising or engaging in other competitive acts intended to solicit or retain business;

(C)
the physician's participation in prepaid group health plans, salaried employment, or any other manner of delivering health services whether on a fee-for-service or other basis;

(D)
a physician's association with, supervision of, delegation of authority to, support for, training of, or participation in a private group practice with, a member or members of a particular class of health care practitioner or professional; or

(E)
any other matter that does not relate to the competence or professional conduct of a physician. (sec. 11151[9])


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